Provider Demographics
NPI:1750495511
Name:DORENFELD, DANA MEREDITH (PA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MEREDITH
Last Name:DORENFELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 BAUCOM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6762
Mailing Address - Country:US
Mailing Address - Phone:704-596-1787
Mailing Address - Fax:704-596-6230
Practice Address - Street 1:3006 BAUCOM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6762
Practice Address - Country:US
Practice Address - Phone:704-596-1787
Practice Address - Fax:704-596-6230
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103089363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0179TOtherBLUE CROSS BLUE SHIELD
NCP38415Medicare UPIN
NC2753319Medicare ID - Type UnspecifiedINDIVIDUAL IDENTIFICATION
NC2320560Medicare ID - Type UnspecifiedGROUP INDENTIFICATION